保健品及减肥产品致肝损伤患者58例的不同诊断方法应用及临床特征分析

Application of different diagnostic methods and clinical characteristics of 58 patients with liver injury caused by dietary supplement products and diet pill

目的:观察保健品及减肥产品导致肝损伤(DS-DPDILI)的临床特征。方法:分析2019年1月至2021年12月解放军总医院第五医学中心58例发病前应用保健品或减肥产品导致肝损伤的中医证型、实验室指标及预后等临床资料。分别采用3种诊断方法[整合证据链法(IEC)、结构化专家意见(SEOP)、因果关系评分(RUCAM)]对DS-DP DILI病例进行诊断。结果:58例患者中女性48例(占82.8%),49例(占84.5%)为肝细胞损伤型。DS-DILI组年龄显著高于DP-DILI组(P<0.05),DS-DILI组初始谷丙转氨酶、谷草转氨酶、总胆红素指标显著高于DP-DILI组(P<0.01,P<0.05),但两组患者预后差异无统计学意义。58例DS-DP DILI患者肝肾阴虚证型(37.9%,22/58)最常见,湿热黄疸证型的治愈率低于其余4种证型(P<0.01)。诊断保健品肝损伤病例时,IEC临床诊断率为43.2%,SEOP为40.9%。诊断减肥产品肝损伤时,IEC与SEOP诊断结果一致,为64.3%。结论:保健品和减肥产品可导致肝损伤,通常预后良好,建议肝肾阴虚人群服用保健品或减肥产品时及时监测肝功能。临床对DS-DP DILI进行诊断时,应综合运用IEC、RUCAM、SEOP,以便更准确判断保健品或减肥产品与肝损伤之间因果关系。

Objective:To observe the clinical characteristics of dietary supplement products and diet pill-induced liver injury(DS-DP DILI).Methods:A study included 58 DS-DP DILI patients from January 2019 to December 2021 who were admitted to the Fifth Medical Center of Chinese PLA General Hospital,those TCM syndrome,lab tests and prognosis were analyzed.Diagnosis was made according to three different diagnostic methods,integrated evidence chain-based causality identification algorithm(IEC),structured expert opinion(SEOP),and roussel uclaf causality assessment method(RUCAM).Results:Among the 58 patients,82.8%were females.A total of 49 cases(84.5%)presented were hepatocellular injury.The age of DS-DILI group was older than DP-DILI group(P<0.05),and ALT,AST,TBil level also higher in DS-DILI group than that in DP-DILI group(P<0.01,P<0.05),however,there wasn’t difference in outcome between two groups.Liver-kidney yin deficiency syndrome(37.9%)was the most common syndrome type.The recovery rate was lower in damp-heart jaundice syndrome type than that in other groups(P<0.01).In terms of diagnosis of dietary supplement products-induced liver injury,the IEC clinical diagnosis rate was 43.2%and the SEOP was 40.9%.Consistent diagnostic results of IEC and SEOP were found in the diagnosis of diet pill-induced liver injury,it was 64.3%.Conclusion:Dietary supplement products and diet pill could induce liver injury.Usually,DS-DP DILI have favorable clinical outcome.People with liver-kidney yin deficiency syndrome should monitor liver function index when they take dietary supplement products.In the clinical diagnosis of DS-DP DILI,IEC,RUCAM and SEOP should be used in combination to accurately judge the causal relationship between drugs and liver injury.